Migraine Surgery May Not Be An Effective Migraine Reliever

Surgery to cure migraines has been popularly touted as a possible, so-called, “cure,” for the incapacitating headaches; however, researchers say that there is insufficient evidence to support the claims.

A review of two studies conducted on migraine trigger “deactivation” surgery revealed a number of flaws in study methods and that the surgery involves risks and high expenses not covered by insurance, according to Drugs.com. Also, according to the research, the surgery does not correlate to what is known about migraine’s underlying causes. The surgery is also known as “nerve decompression” and “trigger point release.”

“The surgery is, first of all, unproven. Second, permanent side effects are not uncommon,” said Dr. Paul Mathew, a neurologist and headache specialist at Brigham and Women’s Hospital in Boston, Drugs.com reported. Lingering issues include persistent itching and numbness in the areas affected by the surgery. Also, the surgery is typically conducted, not by headache specialists, but by plastic surgeons.

Dr. Mathew, who led the research analysis, is scheduled to present his findings this week at the American Headache Society’s annual meeting in Los Angeles, California. Until the findings are published in a peer-reviewed journal, they are considered preliminary, according to Drugs.com.

Ten percent of the global population indicates that they suffer from migraines, according to the U.S. National Institutes of Health (NIH). The unbearable headaches tend to cause symptoms that include intense, throbbing pain on one side of the head; sensitivity to light and sound; and nausea and vomiting. For the most part, headache specialists have expressed skepticism about the surgery that has been used for about 10 years and was developed by Ohio plastic surgeon, Dr. Bahman Guyuron, who discovered that some patients who underwent facial “rejuvenation” procedures reported relief from their migraines, according to Drugs.com.

Since, plastic surgeons have developed other approaches to the surgery, which depends on where they determine the migraine’s “trigger” is located. For example, a surgeon may remove portions of muscle in the forehead or back of the neck, tissue inside the nose, or a segment of the trigeminal nerve (a nerve that runs from the brain to the face and mouth), wrote Drugs.com.

Some small studies reported in plastic surgery journals revealed that most patients report pain relief following migraine surgery; however, the research is too flawed to judge actual efficacy, said Dr. Matthew. The two studies he analyzed are the largest and most broadly cited. One was comprised of 75 patients—49 underwent actual surgery and the remainder underwent a “sham surgery. The other study followed 79 patients for five years following surgery. Although the success rates appeared high, 84 percent of surgery patients reported a 50 percent migraine reduction in the first study, so did 58 percent of those who underwent sham procedures. What’s more, said Dr. Matthew, it was not clear how patient selection was conducted and if the patients had been taking migraine medications before or following the surgery; the study also measured success in nonstandard ways for headache research. “It’s an invasive procedure that has risks, it’s expensive, and it’s unproven,” said Dr. Audrey Halpern, a headache specialist at NYU Langone Medical Center in New York City. “On its face, we should be skeptical.” The approach does not mesh with the biology of migraine, both Halpern and Mathew said.

Research has long revealed that migraines are gene-related; involving a brain dysfunction; and often triggered by sleep disruptions, foods, or estrogen issues. Dr. Mathew said that the underlying issue is “deep in the brain.” It “doesn’t make sense,” Halpern said, that removing a portion of the patient’s facial muscle would eradicate such a complicated brain disorder in many people. Dr. Mathew said that the “placebo effect” is likely to blame and that some patients suffered from pain due to a compressed nerve, which surgery resolved. “No one is saying this shouldn’t be studied as a treatment,” Halpern said; however, surgery should not be marketed as a cure given the out-of-pocket—$10,000 – $15,000—cost, according to Drug.com.

Dr. Mathew advised patients to speak to a specialist for a treatment plan. “Even when people think they’ve tried ‘everything,'” he said, “they’ll probably find that there are treatments they’ve never heard of.” Halpern agreed, noting that new drugs to treat migraine are under development and that migraine sufferers need sufficient sleep, exercise, and nutrition, and should limit stress, Drug.com reported.